Innovative Quality Improvement Research Articles

ECHO+: An Innovative Technology-Enabled Collaborative Learning and Quality Improvement Program Strengthening Rural Primary Care in Arkansas, West Virginia, and Oklahoma

ECHO+: An Innovative Technology-Enabled Collaborative Learning and Quality Improvement Program Strengthening Rural Primary Care in Arkansas, West Virginia, and Oklahoma

Research on the impact of digital transformation on innovative high-quality development in the context of environmental regulation in agricultural enterprises

Digital transformation is an important strategic choice for agricultural enterprises to adapt to economic development in the new era. The innovation quality of patents with core technology and high commercial value is significantly higher than that of low-quality patents such as weak patents developed through technological imitation. This study investigates the impact of digital transformation on innovative high-quality development in the context of environmental regulation in agricultural enterprises for the timeframe from 2012 to 2020. The purpose of this study is to examine whether the goal of improving innovation quality can be achieved through digital transformation in agricultural companies. The results show that digital transformation can effectively promote the improvement of innovation quality in companies, and environmental regulation has a significant positive moderating effect on the relationship between them. “Violating agricultural operation” is a specific appellation for the diversified management of listed agricultural companies, and it is one of the management modes of agricultural enterprises. For listed agricultural companies, the greater the degree of enterprise diversification, the greater the degree of “violating agricultural operation”. The influence mechanism test shows that “violating agricultural operation” plays a part in mediating effect in the process of digital transformation promoting innovation quality improvement.

Interprofessional reconstruction of a policy for academic advancement: The evolution and evaluation of scholarship for today, tomorrow, and beyond

Within higher education, scholarship is narrowly and inconsistently defined, limiting recognition of evolving faculty expectations, particularly for nursing faculty. At this academic medical center, a campus-wide, multi-school, academic advancement policy was achieved with a broader definition of scholarship that included: peer-reviewed publication of federally funded research, as well as innovation in curriculum development, teaching methodology, community engagement, safety and quality improvement, clinical practice, and health policy that would be applicable to tenure and non-tenure track faculty. The background, process, and outcomes of developing an expanded definition of scholarship that encompasses new and evolving areas of scholarship for a reconstructed academic personnel policy is presented. Beginning with a literature review and surveys of other schools' policies, we describe how a campus-wide working group ensured consensus and acceptance of the new policy. Upon approval of the reconstructed document, guidelines for implementation were widely disseminated through training workshops and discussions, integration into new faculty orientation, and faculty development programs. We share our process, outcomes, and lessons learned believing this information to be useful to other institutions engaged in review and revision of their promotion and tenure processes to align with the increasing expectations of nursing faculty of today and tomorrow.

Bilateral Models of Cross-Licensing for Smart Products

Motivated by the new practice of cross-licensing and price competition in smart products, as well as the lack of cross-licensing literature, this article develops a theoretical framework to investigate the incentive for bilateral cross-licensing between two competing firms with asymmetric bargaining power under price competition in smart products. In this article, one firm possesses quality-improving innovation, and another offers cost-reducing innovation for smart products. We find regardless of cost-reducing innovation scale, when the production cost of a holder of quality-improving technology is high enough, the competing firms have the motivation to cross-licensing; compared with a quantity competition, cross-licensing in price competition draws a higher price and producer surplus, but lower consumer surplus and poorer social welfare. This is an interesting finding for the discussion over whether a Bertrand price competition is more efficient than a Cournot quantity competition; and price competition, plus the stability of tacit collusion in cross-licensing, requires that participants have moderate bargaining power. Our article provides a potential explanation for the use of cross-licensing in the smart product industry with price competition, as well as management insights for decision makers by considering different effects elicited by cross-licensing of the smart products.

Improved recognition of lung function decline as signal of cystic fibrosis pulmonary exacerbation: a Cystic Fibrosis Learning Network Innovation Laboratory quality improvement initiative

IntroductionCystic fibrosis (CF) is a systemic autosomal recessive condition characterised by progressive lung disease. CF pulmonary exacerbations (PEx) are episodes of worsening respiratory status, and frequent PEx are a risk...

Impact of intelligent transformation on the green innovation quality of Chinese enterprises: evidence from corporate green patent citation data

ABSTRACT In the context of the rapid integration of artificial intelligence and the real economy, exploring the effects of intelligent transformation on the quality of green innovation in enterprises is of great practical significance. Therefore, this study aimed to identify the impact mechanism of intelligent transformation on the green innovation quality of enterprises based on panel data of listed enterprises in China from 2007–2019. We found that intelligent transformation promotes the improvement of corporate green innovation quality, and the results were robust. Furthermore, intelligent transformation improves the green innovation quality of enterprises through the mediating effects of human capital, research and development expenditure, information sharing effect and factor allocation efficiency. The development of the Internet, the implementation of the National Big Data Comprehensive Pilot Zone and the Broadband China strategy have all strengthened the green innovation quality improvement effect of intelligent transformation. The green innovation quality enhancement effect of intelligent transformation is heterogenous with regard to region, industry factor intensity, industry pollution level and enterprise ownership. Finally, this study provides important policy implications based on its empirical results. Future research should develop more suitable and comprehensive indicators, and focus on the latest data acquisition status to ensure timeliness.

Quality-improving licensing of an outside innovator in a mixed Cournot duopoly

This paper proposes a mixed Cournot duopoly model with private and partially public firms to study an outside innovator's optimal licensing strategy. The innovator decides how and to whom it licenses its quality-improving innovation. We uncover three main findings. First, constrained to exclusive contracts, fixed-fee licensing to the public firm is always optimal. Second, constrained to non-exclusive contracts, fixed-fee licensing outperforms royalty licensing when the innovation size and the private share of the public firm are sufficiently large. Finally, if the innovator can freely decide on contracting exclusivity, fixed-fee licensing to the public firm emerges as the optimal choice. This result holds even when exclusive auction and two-part tariffs are available. We further examine social welfare effects, determining that a conflict regarding contracting exclusivity may arise between the innovator and the state.

The evolution and development of a robotic acute care surgery program.

Acute care surgeons perform more than 850,000 operations annually on emergency general surgery patients in the United States. Emergency general surgery conditions are associated with a disproportionate excess of patient complications and death. Innovative quality improvement strategies have focused on addressing the excess morbidity and mortality among this patient population. Minimally invasive surgical techniques have been shown to reduce the burden experienced by emergency general surgery patients. Still, limited adoption by acute care surgeons has restricted this application's potential. An institutional robotics acute care surgery program provides acute care surgeons additional opportunities to expand minimally invasive surgery access to emergency general surgery patients irrespective of the time or day of the week. A robotics acute care surgery program was developed and implemented at a high-volume academic institution within the division of trauma and acute care surgery. Three attending surgeons and two fellows within the trauma and acute care surgery division had successfully completed a defined robotics clinical pathway. As a result, around-the-clock use of a robotic surgical platform for emergency general surgery cases was implemented with routine use by trained robotic acute care surgeons and practicing fellows. The advancement of robotic surgical technology has opened new avenues for surgical application in the emergency setting. The development of a robotic acute care surgery program allows acute care surgeons to diversify their practice while providing greater access to minimally invasive approaches for emergency general surgery patients.

A Quality Improvement Innovation for Reproductive Health Planning in the Time of COVID.

To see if an outreach approach with telehealth is feasible and acceptable to patients to talk about their reproductive health; and as a secondary outcome, capture data on time spent on the visit and what kind of information was discussed. A registry was created from three family physicians' panels of all adult patients with anticipated ability to become pregnant ages 18-45 who had not had a documented reproductive health discussion in the previous 6 months. Using that registry, outreach was performed to schedule a telehealth visit to discuss their reproductive health with their primary care provider. The visit was standardized using the One Key Question approach. For patients who agreed to participate in the research, the patient completed a survey about their experience. The provider also completed a survey on the time spent and the issues addressed. Two hundred and six patients were called. Ninety patients (44%) could not be reached. Of the remaining patients, 34 scheduled either a telehealth or in-person visit and 7 also agreed to participate in the survey. New information was uncovered in the visit in 86% of participants. The most common need uncovered during the visit was unrelated medical needs (71%), followed by preconception health education/advice (43%) and contraception needs/counseling (29%). Most participants found the telehealth visit valuable. An outreach methodology can uncover unmet health needs, both reproductive and otherwise. We found that people who had the visit often needed something, but a majority of patients declined the visit saying that they did not think they needed it. It is possible that patients are not aware of the value of reproductive health discussions, and therefore clinicians need to take every opportunity to have these discussions whenever possible, whether through outreach or inreach (during already scheduled visits).

The Academic Learning Health System: A Framework for Integrating the Multiple Missions of Academic Medical Centers.

The learning health system (LHS) has emerged over the past 15 years as a concept for improving health care delivery. Core aspects of the LHS concept include: promoting improved patient care through organizational learning, innovation, and continuous quality improvement; identifying, critically assessing, and translating knowledge and evidence into improved practices; building new knowledge and evidence around how to improve health care and health outcomes; analyzing clinical data to support learning, knowledge generation, and improved patient care; and engaging clinicians, patients, and other stakeholders in processes of learning, knowledge generation, and translation. However, the literature has paid less attention to how these LHS aspects may integrate with the multiple missions of academic medical centers (AMCs). The authors define an academic learning health system (aLHS) as an LHS built around a robust academic community and central academic mission, and they propose 6 features that emphasize how an aLHS differs from an LHS. An aLHS capitalizes on embedded academic expertise in health system sciences; engages the full spectrum of translational investigation from mechanistic basic sciences to population health; builds pipelines of experts in LHS sciences and clinicians with fluency in practicing in an LHS; applies core LHS principles to the development of curricula and clinical rotations for medical students, housestaff, and other learners; disseminates knowledge more broadly to advance the evidence for clinical practice and health systems science methods; and addresses social determinants of health, creating community partnerships to mitigate disparities and improve health equity. As AMCs evolve, the authors expect that additional differentiating features and ways to operationalize the aLHS will be identified and hope this article stimulates further discussion around the intersection of the LHS concept and AMCs.

Addressing Health Care Transition Competencies in Nurse Practitioner Education

Coordinating health care transition across care settings is a national core competency for nurse practitioner education. Caring for children and youth with special health care needs requires a collaborative approach to transition from a child-centered to an adult-focused care model. Adding this content is challenging, given the gaps in the health care transition literature and inconsistent faculty expertise. This report describes one university’s innovative quality improvement project aimed at developing competency in health care transition for children and youth with special health care needs among nurse practitioner students. The design, implementation, and evaluation of teaching strategies that resulted in significant knowledge gain for students are reported.

Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): Implementing 21 Components to Catalyze Statewide Improvement in Surgical Care.

In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative (ISQIC). Our objectives are to provide an overview of the first three years of ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21 strategies implemented to support quality improvement (QI), (3) collaborative sustainment, and (4) how the collaborative acts as a platform for innovative QI research. ISQIC includes 21 components to facilitate QI that target the hospital, the surgical QI team, and the peri-operative microsystem. The components were developed from available evidence, a detailed needs assessment of the hospitals, reviewing experiences from prior surgical and non-surgical QI Collaboratives, and interviews with QI experts. The components comprise 5 domains: guided implementation (e.g., mentors, coaches, statewide QI projects), education (e.g., process improvement (PI) curriculum), hospital- and surgeon-level comparative performance reports (e.g., process, outcomes, costs), networking (e.g., forums to share QI experiences and best practices), and funding (e.g., for the overall program, pilot grants, and bonus payments for improvement). Through implementation of the 21 novel ISQIC components, hospitals were equipped to use their data to successfully implement QI initiatives and improve care. Formal (QI/PI) training, mentoring, and coaching were undertaken by the hospitals as they worked to implement solutions. Hospitals received funding for the program and were able to work together on statewide quality initiatives. Lessons learned at one hospital were shared with all participating hospitals through conferences, webinars, and toolkits to facilitate learning from each other with a common goal of making care better and safer for the surgical patient in Illinois. Over the first three years, surgical outcomes improved in Illinois. The first three years of ISQIC improved care for surgical patients across Illinois and allowed hospitals to see the value of participating in a surgical QI learning collaborative without having to make the initial financial investment themselves. Given the strong support and buy-in from the hospitals, ISQIC has continued beyond the initial three years and continues to support QI across Illinois hospitals.

Engaging the creative heArts of nurse educators: a novel conceptual model.

Nurse educators are increasingly challenged in preparing future nurses to be creative thinkers. The purpose of this innovative quality improvement initiative is to share nursing students' interpretations of the value arts-based pedagogy (ABP) brings to their nursing practice. Braun and Clarke's approach to thematic analysis was utilized to identify and report patterns of ideas within learners' interpretations of engaging in an ABP assignment. The analysis of students' interpretations led to the creation of a novel conceptual model to encourage and support nurse educators in the use of innovative ABP approaches. ABP can be seamlessly integrated within teaching and learning methodologies to cultivate meaningful student learning. The intent of the conceptual model is to encourage and support nurse educators in the use of innovative ABP approaches designed for engaging nursing students in active, creative, and challenging learning environments.

Rowan Hillson Inpatient Safety Award 2022

Introduction: The annual National Diabetes Inpatient Audit (NaDIA and NaDIA-Harms) in the UK continues to show significant problems with patient care. During the COVID pandemic patient care has been even more difficult. New initiatives are urgently required to improve inpatient safety for people with diabetes. Method: The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) organised the seventh national Rowan Hillson Inpatient Safety Award on the theme of “the best interventions: redesigning, rebuilding and maintaining safe inpatient diabetes care during COVID”. Result: The winner was the DEKODE team, led by Dr Punith Kempegowda from University Hospitals Birmingham NHS Foundation Trust, for their innovative quality improvement project across hospitals during COVID to improve diabetes-related ketoacidosis (DKA) management and study DKA in people with COVID. Adherence to national guidance improved in some hospitals, with falls in hypoglycaemia, and overall there was a significant improvement in awareness about DKA amongst junior doctors. The King’s College NHS Foundation Trust team, led by Adrian Li and colleagues, received the highly commended award for their innovative project of remote blood glucose (BG) monitoring across healthcare boundaries. This improved diabetes control and tackled health inequalities. Summary and conclusion: These and similar schemes need to be developed, promoted and shared to improve safety for people with diabetes admitted in hospital during COVID times.

The Impact of Total Quality Management on the Saudi Manufacturing SMEs Performance

The Saudi SMEs manufacturing sector suffered a low performance. This study aimed to investigate the impact of total quality management on Saudi SMEs' manufacturing performance and identify which practice of total quality management has the highest impact on Saudi SMEs' manufacturing performance. This study relied mainly on the total quality management indicators suggested by Crosby's model. The data for this study was collected based on a cross-sectional time horizon of 327 staff members belonging to the managerial levels. The findings of this study revealed that both training and employee involvement governance doesn't influence Saudi manufacturing SMEs. However, the rest of the total quality management dimension, namely continuous quality improvement, management leadership, and organizational innovation, have a significant and positive impact on Saudi manufacturing SMEs’ performance. It is strongly advised that the TQM model produced via the current study—which consists of TQM characteristics and benefits—be validated across all business sectors.

Digital Economy, Technological Innovation, and Environmental Quality Improvement

Based on China’s provincial panel data from 2013 to 2020, this paper makes an empirical study on the influence of digital economy development on regional environmental quality by using the fixed effect model and mediating effect model. The results show that the development of a digital economy can effectively reduce environmental pollution and improve environmental quality. Secondly, a mechanism analysis shows that a digital economy can promote technological innovation and improve environmental quality; that is, there is a mediating effect when the total number of patents and utility model patents is a proxy variable of technological innovation, and there is no mediating effect when invention patents and design patents are proxy variables. Finally, through further analysis of regional differences, it is found that the development of the digital economy has obvious regional heterogeneity characteristics to the improvement of environmental quality, and the central and western regions are higher than the eastern regions. These conclusions provide new policy directions and inspiration for improving the regional environment, improving people’s quality of life, and promoting high-quality economic development.

Characterization of potentially avoidable neurological emergency department visits at a large urban public hospital

This study characterized potentially avoidable neurological emergency department (ED) visits at a large urban public hospital. This was a retrospective review of Parkland Health (Dallas, TX) data from May 15, 2021, to July 15, 2021. The study population included encounters discharged home from the ED with any of the following: a primary neurological ED diagnosis, a neurological consultation in the ED, or a neurology clinic referral placed during the ED encounter. Neurovascular, strokelike, acute trauma, and nonneurological cases were excluded. The primary outcome was the number of ED visits by diagnosis category. A total of 965 ED discharge encounters met study criteria as potentially avoidable neurological ED visits, far higher than total neurology-related admissions over the same 2-month period. Headache (66%) and seizure/epilepsy (18%) syndromes were the most common. Thirty-five percent of all cases had neurology involvement in either the ED or the outpatient setting. This was lowest for headache (19%). The revisit rate within 3 months of the index ED visit was 29%, and it was highest for seizures/epilepsy (48%). Potentially avoidable nonvascular neurological ED visits occur frequently, especially for headache and seizure disorders. This study highlights the need for quality improvement and delivery innovation initiatives to optimize the site of care for patients with chronic neurological conditions.

Competition and Innovation in Markets for Technology

We examine the impact of product market competition on innovation in markets for technology. An innovator makes an investment in quality-improving innovation that can be licensed to one (targeted licensing) or all (market-wide licensing) product market competitors. Our model points to a U-shaped relationship between competition in licensee product markets and innovation in the market for technology: at low levels of competition, market-wide licensing is optimal, and competition reduces innovation, whereas at high levels of competition, targeted licensing is optimal and competition increases innovation. Our empirical analysis using a large panel of U.S. data provides clear support for these predictions linking competition, innovation, and licensing.This paper was accepted by Joshua Gans, business strategy.Funding: J.-E. (de) Bettignies gratefully acknowledges financial support by the Social Sciences and Humanities Research Council of Canada [Grant 435-2013-1863].Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2022.4574 .

Diabetic ketoacidosis in children and young people (CYP) at diagnosis across Wales during the COVID-19 pandemic: have the quality improvement (QI) innovations made an impact?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Inpatient Quality-of-Care Measures for Heart Failure: Treatment Gaps and Opportunities in the Contemporary Era.

Quality of care measures are vital tools to assess processes of care within and between health care systems. The 2020 American College of Cardiology/AHA performance measures for heart failure provide a new set of such measures. We evaluated the achievement of these and other performance measures within the Veterans Affairs hospital system in a contemporary cohort of patients hospitalized for heart failure. Hospital discharges from January 2010 to February 2021 with a primary diagnosis of heart failure (n=289 810) were evaluated. Adherence to each measure was determined using the measure's stated definition and by site. Among patients with reduced ejection fraction (53.0%), beta blocker use was high (89.0%), ACE (angiotensin-converting enzyme) inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor (ARNI) use decreased over time (75.3% in 2010, 55.8% in 2020), and hydralazine/nitrate use in eligible Black patients (19.3%) was low. While 68.1% were eligible for ARNI, only 6.0% received them, reaching 17.2% by 2020. Mineralocorticoid receptor antagonists were used in 49.3% of those eligible; laboratory testing 7 days after their initiation was 73.0%, detecting hyperkalemia in 2.2%, although it occurred in 13.7% by 90 days. Achievement of ≥50% target dose was low (beta blocker 45.9%, ACE inhibitor/angiotensin receptor blocker 31.6%, ARNI 19.0%) and for ACE inhibitor/angiotensin receptor blocker/ARNI, decreased over time. Discharge appointments were 56.2% at 7 days and 78.8% at 14 days. Cardiac rehabilitation referral was low (10.5%) but increased. There were significant site-level differences, particularly for hydralazine, ARNI, devices, and cardiac rehabilitation. Important inpatient quality of care measures can be readily measured across the Veterans Administration health care system from electronic health records. Treatment gaps and site-level differences persisted into the contemporary era and will likely be exacerbated as newer treatments are added to this complex baseline. These measures and methods also offer the opportunity to target global, local, and individual processes of care for innovative quality improvement initiatives.